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Case Reports in Medicine
Volume 2013 (2013), Article ID 273957, 5 pages
http://dx.doi.org/10.1155/2013/273957
Case Report

Postprandial Reactive Hypoglycaemia: Varying Presentation Patterns on Extended Glucose Tolerance Tests and Possible Therapeutic Approaches

1Department of Clinical Biochemistry, Good Hope Hospital, Heart of England NHS Foundation Trust, Rectory Road, Sutton Coldfield, Birmingham B75 7RR, UK
2Senior Diabetes Dietician, Department of Nutrition and Dietetics, Heart of England Hospital, Heart of England NHS Foundation Trust, Bordesley Green, Birmingham B9 5SS, UK

Received 1 August 2012; Accepted 27 December 2012

Academic Editor: Peter E. H. Schwarz

Copyright © 2013 Kevin Stuart et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Reactive hypoglycemia is a state characterised by sympathetic or neuroglycopenic symptoms associated with hypoglycaemia in the postprandial state resulting in considerable distress to the patient. It is our practice to carry out either extended glucose tolerance tests (eGTTs) or mixed meal tests in these patients. We describe two patients who experienced hypoglycaemic symptoms early and late during eGTT. The patient who experienced symptoms early, in contrast to the patient who presented with late symptoms, did not possess any characteristics of the metabolic syndrome. Based on clinical symptoms, glucose, insulin, and free fatty acid (FFA) levels, we speculate on possible mechanisms that may have accounted for each of their presentation patterns. We then discuss low glycaemic index diet which will be the mainstay of management.